This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Saturday, 14 March 2009

Stupid People

Not all that long ago I was working a shift as one of two RN's. It was a day shift and we had just had a cardiac arrest.

Another patient on the ward was probably going to arrest. The other RN was at her side with a team of doctors who were fighting to save her.

She was there and I attended and nursed the first patient who arrested and died. Because we were both tied up the cadets and the care assistant were caring for the other patients themselves. They were getting on great with the bed baths and the basic care. But many of those patients were also desperate for medications, interventions, and assessments that can only be done by the nurse.

But we were both tied up.

After the first cardiac arrest the crash trolley was in a hell of a state. If it is not well stocked and organised and an arrest occurs we are totally screwed. I knew that my colleagues patient was about to go.

A few months prior to this on another ward there was a cardiac arrest. The trolley had not been stocked up properly. The patient had a bad outcome. The police took the the list of RN's who were on duty during that shift and the ones prior, ever since the last time it should have been stocked. This trolley is checked over every day by an RN now, much to the chagrin of patients who don't understand what we are doing and think that they are being ignored. It is actually very time consuming.

I knew my colleagues patient was going downhill. I knew the trolley was in a hell of a state and missing vital equipment. I was 10 hours into a shift with no break. I was behind on the work which meant that I was going to have to stay over unpaid to protect my license to practice. The HCA's cannot help me with any of this, other than answering call lights and providing urinals.

AS soon as I dealt with the fallout from my patient who arrested (family etc). My very first job was to sort that crash trolley. My colleague's patient had very seriously started to circle the drain at this point.

There were more call bells ringing than there were people answering them at this point. I tuned that out and went on with stocking the crash trolley.

I was standing in front of the crash trolley figuring out what supplies I needed and was replacing the ambu bag and making sure everything was working when a patient that was watching me decided to put her two cents in.

"In my day, nurses didn't ignore patients and they washed the windows when they had down time" she said.

I didn't have time to reply to her because I heard my colleague shout for the crash trolley. Off to another arrest. Lucky for us there was already a team of doctors and critical care nurses on the ward. I just had to make sure that they had everything that they needed. Seconds count in an arrest situation.

As I was running with the crash trolley to the bedside of the dying patient the patient in the next bed chimed in with her take on the situation.

"I have been here for 2 weeks and never got that kind of attention. I don't think these nurses like me".

When my colleague shouted for the crash trolley I ran to her and the team with it. I had only just got most of it stocked and ready and had to run like Forest Gump to grab items. What I did do is I left some garbage on a table next to the trolley...the wrappers for the supplies etc. I was going to throw them away but then the cardiac arrest call went and I went running with the trolley.

One of the care assistants overheard the first patient comment on that:

"In my day a nurse would have never left a mess like that! Where is the Matron to knock these people into line? In my day matron would have clipped her ear. And look at all these unmade beds. Bring back matron I say".

Hmmm. Maybe I should have washed the windows and made the beds and thrown away the mask packaging before I assisted the crash team.

This is all true. I wish it wasn't.

Does anyone want to speculate on just what the hell is the matter with these people?

A friend of mine had a similar experience when a patient wanted a cup of tea during an arrest on a Nightingale ward. She could see the commotion but argued that she should still have been 'looked after' at the same time.

Yes, because her getting a cup of tea and an updated fbc is much more important than restarting someone elses heart, clearly.

More importantly, did you immediately clean up the mess, wash the windows, wipe down the lockers, whip up a batch of scones and bleach all the bedpans with your spare time?

I feel so much compassion for you. I am thankful that I don't work in the UK. I am truly surprised the UK has ANY nurses at all. I read your blog all the time. I think you should quit. Nobody deserves what you are putting up with day in and day out and I am truly sorry you have to deal with this. It is absolutely unacceptable and inappropriate. They have a department to oversee window washing. It is called HOUSEKEEPING. You don't have time to wash windows. One day you will get fed up to the gills with this and leave. Stop putting yourself through this agony. It is not worth it! You have to put up with too many ignorant and meanspirited people. Do what I'm doing. Plan your exit strategy and get out! It won't get any better, but it will get worse. I should know. I'm a nurse, too.

The situation with the housing market and the economy is really trapping people. Our trust is very isolated. No bupa hospitals nearby. No other hospitals nearby and they are not hiring. Our managers have been heard to say (in regards to us) "Well, they have no where else to go. At all. They will just have to suck it up."

Come on now, get a grip! Why did you not have the floor swept, the open ends of the pillows facing away from the doors and the bed wheels all lined up. Us old nurses would have managed all that - yeah right. I've told you before that the old days were only good because we had a lot more staff on the wards and students were expected (and paid) to work. So don't listen to the moans from people who don't understand, but I think it may be time to move on. Burnout and stress are not just words.

'I've told you before that the old days were only good because we had a lot more staff on the wards and students were expected (and paid) to work.'

GrumpyRN puts it so well. On his recommendation I've just read your post on meal times. You really, really have my sympathy. And the problem is above. You just don't have enough staff on the wards.

I have no idea how we solve this. Somehow we have to put the kudos back in to the work of the wards, rather than developing even more people sitting in offices or standing about with clipboards. The wards are where the acute work gets done, where real nurses like yourself hold the place together.

I try very hard to avoid asking nurses things at mealtimes and drug rounds, and will take phone messages if I am there. Can't usually answer them though as I don't know all the patients, so some poor sod is still left with the task.

I've worked as a healthcare assistant and I am so familiar with this situation. My heart goes out to you, when these things happen it's gets very stressful very quickly.

The patients have no idea what is going on in the rest of the hospital, so many times I had to explain to the patients that the nurses were very busy at the time but would definately get round to doing the drug round soon and no, I can't give you your medication because I'm not allowed. Then having to endure a tirade about how I'm so horrible and how this patient never gets any attention and how the nurses don't like them or we should all be sacked etc. etc.

Frequently I felt so sorry for the hardworking and lovely nurses on our ward and really wished I could do more to help them, there's only so far washing, bed making and toileting can help.

First of all, I have no time to decide whether or not I like a patient.

Secondly, even if I was head over heals in love with a patient he would still feel ignored. We are spread to thin to spend any meaningful amounts of time with patients.

Finally, I would be severely punished for not prioritizing properly by everyone from the NMC to the legal system. This means that if Adolf Hitler is in bed A and he is medically unstable and my own dear mother is in bed B and stable with a bit of pain...Hitler gets more time and attention. Full stop.

I am a desperatley busy OT, but try and help as much as I can on the ward when I've got a spare 5 minutes. Sometimes I hate the looks and comments I get from patients and relatives who expect me to be able to do anything they ask - 'I'm not a nurse' is apparently not a valid answer where I work! I've taken to deliberately ignoring the phone at the nurses station when it rings, because I never know the answer to the question the person at the other end is asking, and I have to go and drag someone away from what they're doing ho does know the answer. But in the eyes of patients and relatives, my not picking up a ringing phone just makes me look lazy and not willing to help the ward team out!

From an OT point of view the patients have the same unreasonable expectations of their demands on our time - I can't take Mr Brown on a home visit today because he was only refered to me yesterday and I'll be fitting Mr Green's equipment today, which is essential for his discharge. I don't care if that means you have to take time off work to let me in to the house with Mr Brown to do his home visit tomorrow- the man is your father, maybe he could be trusted to look after his own front door key for one night in hospital? Oh yes, but then that would mean you wouldn't be present at the home visit so wouldn't be able to stick your oar in every 5 minutes about what Mr Brown can and can't, in your opinion, do for himself.

"I was standing in front of the crash trolley figuring out what supplies I needed and was replacing the ambu bag and making sure everything was working when a patient that was watching me decided to put her two cents in.

"In my day, nurses didn't ignore patients and they washed the windows when they had down time" she said. "

When Stafford Hospital was investigated by the Healthcare Commission, they found that a crash trolley had not been checked for some months. The nurses were probably too busy washing windows...

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.